Participant experiences in the Diabetes REmission Clinical Trial (DiRECT)
Open accessAbstract
Introduction: The Diabetes REmission Clinical Trial (DiRECT) has shown that sustained remission of type 2 diabetes in primary care is achievable through weight loss using total diet replacement (TDR) with continued behavioural support. Understanding participants’ experiences can help optimise the intervention, support implementation into healthcare, and understand the process of behaviour change. Methods: Thirty‐four DiRECT participants were recruited into this embedded qualitative evaluation study. In‐person and telephone interviews were conducted before the TDR; at week 6–8 of the TDR; 2 weeks into food reintroduction (FR); and at 1 year, to learn about participant experiences with the programme. Transcribed narratives were analysed thematically, and we used interpretation to develop overarching themes. Results: Initiation of the TDR and transition to FR were challenging and required increased behavioural support. In general, adhering to TDR proved easier than the participants had anticipated. Some participants chose the optional extension of TDR. Rapid weight loss and changes in diabetes markers provided ongoing motivation. Further weight loss, behavioural support and occasional use of TDR facilitated weight loss maintenance (WLM). A process of behaviour adaptation to change following regime disruption was identified in three stages: (1) expectations of the new, (2) overcoming difficulties with adherence, and (3) acceptance of continuous effort and establishment of routines. Conclusions: The DiRECT intervention was acceptable and regularity, continuity, and tailoring of behavioural support was instrumental in its implementation in primary care. The adaptation process accounts for some of the individual variability of experiences with the intervention and highlights the need for programme flexibility.
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Weight loss may not be the goal for some patients, and many people are actively seeking to reduce the number of medications that they take.
“Weight loss may not be the goal for some patients, and many people are actively seeking to reduce the number of medications that they take.”
From The societal implications of using glucagon-like peptide-1 receptor agonists for the treatment of obesity (2025) · cites this paper as [64]
The ‘Expectations of the total diet replacement’ section (page unavailable) reports that the prospect of not taking medication encouraged participation, and quotes a participant hoping to stop metformin. The Conclusions (page unavailable) also describe freedom from diabetes medication as an attraction. The paper does not establish that weight loss was not a goal for some participants or that many people generally seek to reduce the number of medications they take. (LLM, conf=0.85)
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- Authors
- Rehackova, L., Rodrigues, A. M., Thom, G., Brosnahan, N., Barnes, A. C., McCombie, L., Leslie, W. S., Zhyzhneuskaya, S., Peters, C., Adamson, A. J., Lean, M. E. J., Taylor, R., & Sniehotta, F. F.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Northumbria University (GB)
- University of Glasgow (GB)
- Newcastle University (GB)
- University of Newcastle Australia (AU)
- Corresponding author
- Rehackova, Lucia
- ORCID
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2021-09-18
- Volume
- 39
- Issue
- 1
- Pages
- e14689-e14689
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W3200679388
- Cited by
- 46
- References
- 27
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 16 · 2023: 7 · 2022: 4 · 2021: 2
- FWCI
- 5.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- University of Twente Research Information (submittedVersion)
- Funders
- Diabetes UK
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes remission, total diet replacement, weight loss, behavioral support, participant experiences, food reintroduction, weight loss maintenance, behavior change, intervention adherence, primary care, DIRECT trial
- MeSH terms
- Aged, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Motivation, Weight Loss, Caloric Restriction, Qualitative Research, Weight Reduction Programs
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